Thursday, March 2, 2017
Twelve referrals in nearly 60 days sounds like nothing at all. But for Marina — a single mom with an adult child locked up in one of the County Jail’s isolation cells for crimes committed under the influence of schizophrenia — it’s the answer to six years’ worth of prayers.
When Laura’s Law went into effect in Santa Barbara County on January 1, Marina (not her real name) was one of the first to call the Department of Behavioral Wellness. The law — still controversial in many quarters — gives local judges the power to order the most treatment resistant of the seriously mentally ill into outpatient care.
By any measure, Marina’s son qualified. In the past six years, he’s been jailed four times for various misdemeanors and placed in psychiatric hospitals eight times. Four times, he was sent to the County’s Psychiatric Health Facility (PHF), better known as “the Puff Unit.” Twice he was dispatched to the Aurora Vista del Mar facility in Ventura County, and two times he was placed in facilities out of state.
After graduating from a four-year college and holding down a steady sales job, something happened to Marina’s son. He started hearing voices. He thought he was Jesus. His reality and that of everyone else’s diverged dramatically. And he’s evidenced no interest in taking any of the medications designed to bring his schizophrenia under control.
Until Laura’s Law went into effect, the future looked bleak for Marina. Her son made it hard for county mental-health workers to help. He was reclusive, withdrawn, and hard to find. And with massive caseloads, it’s not like they had time to chase him down. All that appears to have changed under Laura’s Law. “They go out to where the person is,” Marina said. “If he’s not there, they find another way to get in touch.”
When Marina first sought help under Laura’s Law, her son was contacted by a caseworker within 24 hours. When he was popped into County Jail three weeks ago, the caseworker visited him there, spending half an hour talking with him. That, to Marina, is amazing enough. Even more, her son signed a release allowing his caseworker to discuss details of his situation with his mother. That, in Marina’s experience, is beyond unheard of.
Even though Laura’s Law does not empower judges to force patients to take their medications — or lock them up for refusing — critics have attacked the measure’s coercive aspects while supporters have lauded the transformational benefits of what they call “black robe therapy.” In reality, as was discussed at a public hearing convened by mental-health advocates last week, the vast majority of Laura’s Law cases never go before a judge. In Los Angeles County last year, for example, only three out of nearly 400 cases involved judicial intervention.
The real benefit of Laura’s Law, said Lieutenant Eddie Hsueh (pronounced “shway”) of the Santa Barbara County Sheriff’s Office, is that it requires overworked county mental-health workers to take the extra step. “It makes them go and seek these people out,” Hsueh said. “If you’re mentally ill, you probably aren’t going to seek out such help yourself.” What makes this possible, said Hsueh — a 31-year veteran of the department who is spearheading efforts to train every law enforcement officer in the county how to better understand and communicate with the mentally ill — is a much-reduced case load.
While a typical mental-health worker involved in the county’s Assertive Community Treatment (ACT) program might have 100 clients, their counterparts working the Laura’s Law beat have no more than 10. Their marching orders, explained Pam Fisher — second in command at Behavioral Wellness — is to engage, engage, engage, no less than three times a week. “Even if they refuse treatment, and they’re still willing to talking to us, we can continue to engage,” she explained. This goes on for at least 90 days. After that, Fisher said, legal steps can be initiated that might eventually put someone in front of Judge Colleen Sterne. For that to happen, the individual has to have been hospitalized and jailed within the past two years, refused treatment, and be deteriorating to such an extent their safety is in question.
To date, 12 referrals have been made in Santa Barbara County: nine by law enforcement officials — one by Lt. Hsueh — and three by family members. Of those, two agreed to seek treatment. One was Marina’s son. The rest remain in the process of engagement. Under the county’s pilot program, there’s room for no more than 10 clients at any given time. But once one agrees to treatment, that creates a space for someone else.
For mental-health advocates, the struggle to establish Laura’s Law in Santa Barbara has been hard fought and endlessly fraught. With a serious budget crisis looming over county government — accompanied by a serious shift in the political winds — their victory is far from secure. With the budget year half over, Behavioral Wellness is projecting a $5 million cost overrun. And that doesn’t count the $1 million in cuts the department is slated to take as a result of mounting pension problems.
Given that department head Alice Gleghorn strenuously resisted Laura’s Law until former supervisor Doreen Farr forced it upon her after waging a sneaky legislative attack — the new program distracted limited resources from more pressing institutional reforms, Gleghorn argued, and its benefits were overstated — mental-health advocates worry Laura’s Law may have a terminal dearth of friends in high places. Its strongest advocates, Farr and former supervisor Salud Carbajal, have since moved on. Farr, whose son has experienced serious mental-health issues, retired, and Carbajal, who lost two close family members to suicide by the time he graduated college, has been elected to Congress.
It’s uncertain how supportive their successors — supervisors Joan Hartmann and Das Williams — will be when this year’s budget battles commence. While the $660,000 that Laura’s Law costs the county may seem like chump change in the context of the $100 million spent annually by Behavioral Wellness, every dollar will be up for grabs.
“Already we’re hearing about money problems,” warned longtime mental-health advocate Ann Eldridge at last week’s Laura’s Law meeting. “Keep your eyes open. There’s going to have to be some lobbying done.”
In the meantime, Marina’s son remains locked up in County Jail. He’s waiting for space in the Psychiatric Health Facility to open up. Given the intensity of the demand and the paucity of bed space — only 16 — he could be waiting a long time. “Have you been in an isolation cell?” Marina asked. “My son is not a criminal. It’s crazy.”